Provider Demographics
NPI:1164856969
Name:HUTSON, JENA ELISE (MSN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JENA
Middle Name:ELISE
Last Name:HUTSON
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 E CENTER ST
Mailing Address - Street 2:#1
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2489
Mailing Address - Country:US
Mailing Address - Phone:423-247-2263
Mailing Address - Fax:423-246-1943
Practice Address - Street 1:1335 E CENTER ST
Practice Address - Street 2:#1
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2489
Practice Address - Country:US
Practice Address - Phone:423-247-2263
Practice Address - Fax:423-246-1943
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I500731Medicare PIN